Possible causes for failure of total knee endoprostheses represent wear, malpositioning, maldimensioning and inadequate design of the implant components, manufacturing defects, material fatigue, corrosion, overloading, infection, and allergy against implant materials. There is a broad spectrum of methodical approaches for the analysis of failure cases. Substantial information for the damage analysis is provided by clinical and intraoperative findings, photo documentation, radiographic course as well as all-solid, physical and histological investigations. Principal purposes of damage analysis are the avoidance of further damage events and the gain of information for improvement of implant design and material as well as the optimisation of the biocompatibility of implants and wear products. Both a detection system of incidents and implant failures as well as a complete data collection enables early identification of system-specific, accumulated cases of implant failure.